Contemporary Management of Adrenal Insufficiency: A Comprehensive Review of Diagnostic Strategies, Therapeutic Interventions, and Long-Term Monitoring

Adrenal insufficiency (AI) is a life-threatening endocrine disorder characterized by inadequate production or action of glucocorticoids, with or without deficiency in mineralocorticoids and adrenal androgens. The condition can be primary (due to adrenal gland dysfunction), secondary (due to pituitary dysfunction), or tertiary (due to hypothalamic dysfunction). The management of AI has evolved significantly over the past decade, with advancements in diagnostic modalities, glucocorticoid replacement therapies, and patient education. This article provides a comprehensive review of the current diagnostic approaches, including dynamic endocrine testing and imaging studies, as well as the latest therapeutic strategies, such as individualized glucocorticoid dosing, dual-release formulations, and the emerging role of circadian rhythm-based therapies. Additionally, the importance of patient education, self-management, and long-term monitoring to prevent adrenal crises and optimize quality of life is emphasized. The review also highlights the challenges in managing special populations, including pediatric patients, pregnant women, and those with concurrent comorbidities. By integrating the latest evidence-based practices, this article aims to guide clinicians in delivering optimal care for patients with adrenal insufficiency.